GPs need further training in order to understand how to care for the transgender community, the first cross-party parliamentary inquiry on the matter has advocated.
The report said that GPs, as gatekeepers, are vital and need a better understanding of: trans identities; the diagnosis of gender dysphoria; referral pathways into Gender Identity Services; and their own role in prescribing hormone treatment.
The Beaumont Society, a trans community organisation, told the inquiry about the “astonishingly negative reaction by a few GPs” when a trans person appears for the first appointment to ask for an assessment to begin. “You’ll be taking money away from more deserving cancer patients” is one quote that is quoted in the report.
When referrals to Gender Identity Services do happen, they are provided as part of mental-health services. “This is a relic of the days when trans identity in itself was regarded as a disease or disorder of the mind and contributes to the misleading impression that this continues to be the case,” the inquiry stated.
NHS England, also admitted in the inquiry that that there was an “unwillingness by some general practitioners to prescribe and monitor hormone therapy,” and a “matter of serious day-to-day importance at a primary care level is the persistent refusal of some general practitioners to even make referrals to gender identity clinics,” the report added.
The inquiry is also calling on government to agree a new strategy on trans equality, including the NHS, which has full cross-departmental support within the next six months, and a “root-and-branch review” of this matter to also be conducted, completed and published within the next six months.
The General Medical Council must also provide “clear reassurance that it takes allegations of transphobia every bit as seriously as those concerning other forms of professional misconduct”.
What GPs must do – from RCGP guidelines
1. Be understanding. A negative reaction can do serious harm.
2. Get names and pronouns correct (ask discreetly if necessary).
3. Be aware of the importance of medical confidentiality.
4. Be conscious that co-existing health issues may not be linked to gender issues.
6. Support the treatment set out by gender service.
7. Consider signposting to sources of support within the community and voluntary sectors.
8. Understand and use appropriate terminology. Transgender is an umbrella term for people whose gender identity and/or gender expression differs from the sex assigned to them at birth, they may or may not decide to alter their bodies hormonally and/or surgically. Transsexual equals a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex. In the trans community cross-dressing is seen as a pejorative term and is not used.